video lesson presented by radsaf™ ...inspections and corrective actions as required by the quality...

Video Lesson Presented by RADSAF™www.RADSAF.com

Copyright© 2018 All Rights Reserved

INTRODUCTION

There are many facets and divisions where ionizing radiation safety is categorized and monitored

State regulatory agencies monitor radiation safety protocols differently

Copyright© 2018 All Rights Reserved 2Radiation Safety Practices for X-Ray Technologists

INTRODUCTION (Continued)


Where you work:

The regulations pertaining to ionizing radiation fall into the

Medical Category

Radiation Safety Practices for X-Ray Technologists 3

Participation is a mandatory review

Designed to educate operators on the harmful effects of radiation

Provides quality control guidelines to ensure best safety practices for you and those working around you


INTRODUCTION (Continued)


HISTORY OF X-RAYS

Discovered on November 8th 1895 by Wilhelm Roentgen

German-Dutch mechanical engineer and physicist


Understanding how x-rays are created is not required in this presentation, but a short history about the discovery of x-rays and the reason we require caution when using x-rays is a good fundamental start to this presentation



HISTORY OF X-RAYS (Continued)

VACUUM TUBE

BARRIER

PHOSPHORESCENT POWDER

ENERGY RAYX-RAY

ON


Presented his wife’s hand x-ray to medical board




Thomas Edison and Clarence Madison Dally set out to make x-ray invention more useful to the medical community

Dally became the first casualty of x-ray radiation overdose

X-rays were then deemed useful but harmful. Measurements and control needed to be established




THE ENERGY SPECTRUM: TWO TYPES OF RADIATION


Ionizing Radiation High Frequency

Wavelengths

Cosmic, Gamma and X-Rays

Non-Ionizing Radiation Low Frequency

Wavelengths

Radio, Microwaves, Infrared, Visible Light and Ultraviolet waves



ALARA DEFINED:

ALARA is a common acronym which stands for:

“AS LOW AS REASONABLY ACHIEVABLE”

It is the professional practice of maintaining a high standard of radiation safety for the patient as well as for the staff


X-RAY DEPARTMENT HIERARCHY


Administrators & Staff Doctors

On-Site Radiation Safety Officer (RSO)

Physicist

C-arm Operators RT (R)

Administrators & Staff DoctorsCreate the quality assurance policies & guidelines for the x-ray department

OR Staff & Nursing Staff

Medical PhysicistPerforms yearly quality control testing on all x-ray units. This yearly test survey assures that the x-ray unit is operating properly and to manufacturers specifications




On-Site Radiation Safety Officer (RSO)Performs periodic testing, daily visuals, monthly phantoms, quarterly tests & yearly lead scans (Quality Control )

Monitors dosimetry badge levels & fluoro times

Provides daily radiation safety motivation



Physicist








Physicist



C-arm Operators RT (R) Typically licensed or registered within the state.

Maintain, monitor & report all radiation safety issues or concerns to managers

Often designated as RSO because of their educational background in x-ray

Practice ALARA, shield patients and maintain daily radiation safety motivation




OR Staff & Nursing StaffMust be aware of radiation safety policies

Always Practice ALARA



Physicist




COMPONENTS OF A RADIOLOGY DEPARTMENT

Develop Departmental Hierarchy Enforce Radiation Safety Policies Provide Qualified Staff/Operators Designated Radiation Officer (RSO)

Daily Equipment Protocols Periodic Equipment Testing (Month/Qtr) Review Staff Exposure Records

Ensure Warning Signs Are Displayed Communicate and Record Fluoro Times Maintain X-Ray Records For 10 Years Yearly Physicist Equipment Survey Yearly In-Services to Staff

Copyright© 2018 All Rights ReservedRadiation Safety Practices for X-Ray Technologists 15

QUALITY ASSURANCE VS QUALITY CONTROL


Quality Assurance

• A manual based on a description of the policies and protocols required to run a radiology department properly

Quality Control

• The actual process of testing and recording by way of continued inspections and corrective actions as required by the quality assurance manual


BASIC RULES OF RADIATION PROTECTION


DECREASE TIME INCREASE DISTANCE INCREASE SHIELDING

ALWAYS REMEMBER ALARA!


X-RAY CHARACTERISTICS An x-ray’s intensity is made

up of two main factors: Strength or Energy Number of x-rays produced

An x-ray’s intensity is proportional to the inverse square of the distance that they travel


The Inverse Square Law

Strongest & Most Concentrated

Intensity Decreases Rapidly as the X-ray Spreads Out


CHRONOLOGICAL COURSE OF X-RAYS


PATIENT ANATOMY

X-RAY TABLE

IMAGE RECEPTOR

PRIMARY SOURCE

<- - PRIMARY USEFUL BEAM

X-RAYIMAG

EPRIMARY BEAMWORKER

<- - X-RAY TUBE

PRIMARY BEAM

<- - SECONDARY SOURCE

<- - SCATTER RADIATION

ABSORBED DOSE


DOSING & HOW IT EFFECTS THE BODY

Some doses may be completely harmless, stronger doses or an accumulation of dose may be harmful to the human body

1 in 40 people are potentially more susceptible to the damagingeffects of ionizing radiation then others


UNITS OF MEASURE

On radiation dose reports you will see a unit of measure called rem

A representation of the relative risk of a radiation exposure to a person

A person’s radiation absorbed dose

Dose reports are recorded in millirem (mrem)

mrem is 1/1000th of a rem


UNITS OF MEASURE (Continued)


The most commonly accepted set standard, for yearly exposure limits for healthcare workers is 5 rem per year

State and federal regulatory agencies request monitoring to assure that exposed workers are within these limits

The maximum dose per year for a declared pregnant woman is 500 mrem or .5 rem per year


RADIATION BADGE


If you were issued a radiation badge, then it should be worn at all times when around areas where you may come in contact with ionizing radiation

All those wearing a radiation badge should be tracking and aware of their dose reports


RADIATION BADGE (Continued)


Dose reports provide radiation safety officers the ability to control your exposure and keep you safe

Worn outside the lead apron at collar level or breast pocket level, this badge picks up the scatter radiation that we are working in




Common badges are made up of attenuating filters and include a piece of x-ray film that is developed, and used to calculate your mrem exposure

These badges are mailed in quarterly, developed and a report is generated and sent to your radiation safety officer


X-Ray Film Badge



New technology such as Bluetooth and USB devices allow a person to see their dose as readily as they prefer, not just quarterly.


To purchase radiation badges, please visit:www.RADSAF.com



Tips about radiation badges:

Proper placement is on the outside of the lead apron

They should never be removed from the facility

They should be stored in a location away from live radiation work areas

Film badges can become contaminated if left in extreme temperature areas, such as automobiles




Tips about radiation badges:

Badge readings can be false or inaccurate or contaminated If this is the case, your Radiation Safety Officer (RSO)

should investigate thoroughly

Radiation badges give your RSO a dose report which can be monitored and used as a quality control instrument to assure staff radiation safety


RADIATION DOSE REPORTS

Your facility’s RSO will be submitting and processing staff badges consistentlythroughout the year!


JANUARY FEBRUARY MARCH

APRIL MAY JUNE

JULY AUGUST SEPTEMBER

OCTOBER NOVEMBER DECEMBER

Example: Badges processed quarterly

You have a limited time window to turn in or process your badge

In most cases your RSO will request that it is done in a chosen month


RADIATION DOSE REPORTS (Continued)


Dose report readings are recorded in millirem, that’s 1/1000th of a rem

If you acquire a cumulative deep dose reading of 5 rem or 5000 mrem, then you have reached the standard dose limit, and you cannot work in live radiation work areas


CARE & MAINTENANCE OF PERSONAL PROTECTIVE GEAR

Aprons are made of attenuating elements contained within a rubber like material

If not taken care of properly aprons crack and expose us to ionizing radiation



Folding lead aprons will increase the cracking potential of the lead barrier which reduces the lifespan of the apron



Always remember to hang up lead aprons for storage

When not in use, hang or drape them to reduce folds



PLEASE NOTE:

Lead aprons are expensive to replace

If you notice wear or any need for an apron repair, point it out to your RSO


WEARING YOUR LEAD APRON

Properly worn personal protective gear is mandatory in an x-ray environment

Buckles and straps should be fastened properly

Thyroid shields should be available for use


WEARING YOUR LEAD APRON Your radiation badge should

be worn outside your lead apron at collar level

If you are wearing one sided lead aprons, never turn your back to the active x-ray tube


REPORTING & DOCUMENTATION OF C-ARM ISSUES

At the start of each day: Turn on c-arm Wipe down (BoH procedure) Complete visual inspection Sign-Off

Report any issues to your supervisor Document all issues in the RADSAF

Technologist’s Workbook Follow up report to ensure repair

service was conducted Reports should also be kept in the

RADSAF Retention Binder


• The RADSAF Technologist’s Workbook is designed to track the daily use of each machine

• It tracks the quality control testing and safety protocols required by the state and designed by your facility

• All workbooks are located and stationed with each x-ray machine at all times


C-ARM “IN USE” RECORD KEEPING


C-ARM “IN USE” RECORD KEEPING (Continued)

It is important for c-arm operators to become familiar with the tech workbook, know its location and be able to perform and document the quality control testing

Wiping down and visual inspection procedures are expected to be documented

Mini c-arms must also be tracked daily

Fluoro log books record PT exposure times and dose: Stored and secured at the end of each day

HIPPA violation to leave patient information unsecured

Depending on facility policies, fluoro times are either recorded in a patient’s folder, or stored in the fluoro logbook


C-ARM FACTS & UPKEEP A c-arm is a complicated piece of

equipment It contains many fragile parts that are

calibrated for safe use These two main parts of the c-arm

need to be taken care of to maintain proper usage and patient safety when in use

Banging or striking these parts will result in costly repairs and recalibrations


Average Repair Costs


C-ARM FACTS & UPKEEP (Continued)


Document All Service and Testing

Conduct Quality Control Tests Regularly

Report Issues to Your Supervisor

Keep Your Machine Clean


TROUBLESHOOTING C-ARM ISSUES


STOP You do not want to over expose a patient or create a hazardous condition in an operating room

LOOKStep back. Look at what your c-arm may be telling you. Is

there an error code? Lights flashing? Perhaps a button was pushed accidentally?

LISTENListen for audible warnings, or out of the ordinary mechanical noises. Depending on where the noise is

can determine the seriousness of a malfunction

THINK

Is anything out of place? If necessary, remove the primary beam away from the patient, and ask yourself, will taking another exposure clear an error code or fix

the problem? Will rebooting be your next option?


ELECTRICAL HAZARDS Look out for wires that are loosely attached,

exposed or frayed Be vigilant to ensure that all plugs and outlets

are working properly


ELECTRICAL HAZARDS (Continued)

Keep an eye out for water and other electrical conducting elements that may endanger your patient, or interfere with patient monitoring

Report all potential hazards immediately to your supervisor In the event of any major electrical malfunction on your c-arm,

always use the emergency shutoff switch


STANDARD RADIATION SAFETY POLICIES

Every radiology department has a radiation safety policy in place

We will be reviewing the general radiation safety policies that are the “standard of practice” in most facilities

In this next section we will present to you a quick and fast review of these policies

Any questions or concerns, please ask your RSO, managers or administrators after this presentation is over


Must wear proper protection and radiation safety badges when working with x-ray

Never expose anyone, including staff, purposely or to self diagnose

All staff should practice ALARA Appropriate x-ray signs should be displayed in designated

areas Employees that test x-ray equipment must have appropriate

education


GENERAL POLICIES:



Only in life threatening situations Persons holding must be over 19 years old No body parts of person holding patient should

be in x-ray field Proper lead protection must be worn Only staff personnel can hold a patient, no family

members or outside representatives


HOLDING PATIENTS DURING FLUOROSCOPY:



Only those necessary to perform patient care

Only those training or equipment maintenance

The Center shall provide sufficient exposure protection for all those in the room

Wearing protection is NOT a request or option, it is a requirement


INDIVIDUALS PRESENT IN THE ROOM DURING FLUOROSCOPY PROCEDURES:



Reminder signs are posted throughout the Center Efforts made to keep pregnant staff out of fluoro rooms Extra shielding and two dosimetry badges Patients of child bearing age are to be questioned about the

possibility of pregnancy Continuance to procedures may require:

Verbal / written or signed denial of pregnancy Urine Pregnancy Test Results of pregnancy test via patients primary physician.


POLICY FOR PREGNANT STAFF & PATIENTS:



Patients under 18 must be protected by shielding whenever possible

Gonadal shielding is .5mm lead equivalent If documentation of patient sterility is present,

then shielding may be omitted Patient shielding should be utilized when ever

possible especially when it does not interfere with the anatomy being worked on


GONADAL PROTECTION & PATIENTS UNDER 18:



The center provides each individual their own radiation dosimetry badge

Quarterly readings are available to staff upon request

Badges never leave the center Badge readings are stored up to 10 years Questions or concerns are to be addressed to

management


PERSONAL RADIATION MONITORING:



Center is committed to quality control testing and preventative maintenance

Maintaining equipment and keeping service records

Repairing equipment to manufacturer’s specifications

Performing yearly testing and physicist surveys

Maintaining documentation retention of testing results and fluoro time logs


QUALITY CONTROL POLICY:



RADIATION SAFETY PROTECTION TIPS Pointers and tips you can use to protect yourself and others while

working with ionizing radiation:

Never place your hands, fingers or arms into the primary beam or within the field of view shown on the monitor screen

If you find yourself working really close to an operative site, wear a thyroid collar and if available wear protective eye glasses

Since we never exposure ourselves to the primary beam, our worst enemy is scatter radiation


RADIATION SAFETY PROTECTION TIPS 12 Useful tips to reduce your scatter radiation exposure:

It is best to utilize a properly trained c-arm operator

Distance is your friend; take a short step away from your patient each time you take an x-ray

Use low dose fluoroscopy applications

Use the pulsed fluoroscopy mode if you must use “live” x-ray

Perform multiple c-arm movements, then take one exposure

Limit “live” fluoroscopy whenever possible; single exposures are best

Use collimation whenever possible

Save images for references to limit repeat exposures

Use the hand exposure switch rather than the foot pedal. Exposure lag times increase when using the foot pedal


RADIATION SAFETY PROTECTION TIPS 12 Useful tips to reduce your scatter radiation exposure:

Take notice to the distance of the image intensifier to the exposed anatomy. The closer your intensifier is to the anatomy, the less scatter is produced. This technique also improves the detail in your final image

In the torso section of the anatomy, shooting a lateral projection requires more dose, so stand back or step away if possible

Do not leave radiopaque objects, such as instruments or retractors in the field of view; they increase the dose technique as the image receptor compensates for the added attenuating materials


THANKS FOR WATCHING! Thank you for taking the time to watch, learn, and listen to

the important radiation safety policies and measures that your facility has put into place for your overall safety

Your RSO may ask you to take a brief competency test or sign off on this required radiation safety educational tutorial

If you have any questions or concerns please address them to your RSO


For information pertaining to purchasing new lead aprons and other radiation protection gear, please visit our website, call, or email us at :

www.RADSAF.com

877-774-XRAY (9729)Or [email protected]

BE SAFE… BE RADSAF!

http://www.radsaf.com/

Video Lesson Produced by RADSAF™Written & Narrated by Timothy DiFelice

Audio recordings and visual content created by Steven GittoMusic by BenSound

www.RADSAF.com

This video may not be copied or reproduced without the written consent of RADSAF™.

Copyright © 2018 All Rights Reserved.

video lesson presented by radsaf™ ...inspections and corrective actions as required by the quality...

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